Sleep problems in the UK highlighted

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Behind the Headlines

Thursday January 27 2011

Insomnia has been linked to mental health issues

“Nearly a third of the population are suffering from insomnia which is affecting their health,” reported the Daily Mirror. It said that a survey of the nation’s sleep habits found that 30% are severely sleep deprived, putting them more at risk of mental health and relationship issues.

Several other newspapers also covered this story, based on a report by the Mental Health Foundation that aims to raise awareness of the importance of sleep for physical and mental wellbeing. Much of what it says in this area is uncontroversial and appears to be sound advice.

The report is not a scientific review and the results of the survey it includes should be viewed cautiously, since the 6,700 people who responded were perhaps more likely to have sleep problems and may not be truly representative of the UK population.

What are the news stories based on?

The stories are based on a new report on sleep, published by the UK’s Mental Health Foundation, aimed at raising awareness of the importance of sleep. The report includes an ongoing survey of over 6,700 people, supposedly the largest survey ever of the UK’s sleep habits. The online survey was carried out by an organisation called Sleepio, which found that only just over one third of respondents were classified as “good sleepers”, while more than a third were classified as possibly having chronic insomnia.

This report also describes the nature of sleep and highlights its importance for physical and mental wellbeing, drawing on a number of different sources. It is not a scientific review and the results of the survey it includes should be viewed cautiously since it is possible that those who responded were more likely to have sleep problems and may not be truly representative of the UK population.

What did the survey find?

Based on individual answers given in the survey, the authors calculated average sleep scores for each respondent (0% = very poor, 100% = excellent).

The main results showed that:

Men’s average sleep score was 61%, compared to 57% for women.

People who said they were in poor health had poorer sleep (average sleep score of 47%) than those who rated their health as good (average sleep score 63%).

Average sleep score tended to decrease with age.

Only 38% of the respondents were classified as “good sleepers”.

36% were classified as possibly having chronic insomnia.

79% of those with insomnia reported having it for at least two years.

Over four times as many people with insomnia reported relationship difficulties, compared with good sleepers.

Over 45% of those with insomnia had difficulty staying awake during daylight hours compared with just over 10% of good sleepers.

Nearly 95% of people with insomnia reported low energy levels in their daily lives, compared with over 40% of good sleepers.

Over 75% of people with insomnia experienced poor concentration.

Importantly, anyone could take part in the online survey and there was no sampling described. This means that those prepared to answer online may be more likely to have sleep problems than a general population sample. For example, unequal proportions of men and women responded, with 1,870 responses from men and 4,838 from women (total = 6,708). The average age of respondents was 40 for men and 37 for women.

Other sleep problems highlighted by the report

The report also covers other sleep-related problems such as oversleeping, narcolepsy, snoring, sleep apnoea, nightmares and night terrors, sleepwalking and teeth grinding.

The effect of insomnia and poor sleep

The authors say that insomnia is a massive public health problem, and the most commonly reported mental health complaint in the UK, with up to one third of the population experiencing it. Typically, it involves a “vicious cycle” of racing thoughts, poor sleep, anxiety about poor sleep and “unhelpful” patterns of thoughts and behaviour. Catching up on sleep during the day may then make it difficult to get to sleep at bedtime.

Insomnia and poor sleep can affect mood and concentration levels and in rare cases may be fatal, the report says. It is often linked to physical problems and to periods of stress and worry.

What does the report recommend?

The report’s recommendations include the following:

The importance of good sleep should be highlighted in public health campaigns.

GPs should be trained on the benefits of sleep.

Public health strategy should include a specific objective to reduce sleep problems.

New national guidance is needed on managing insomnia using non-drug treatments.

People with sleep problems should have access to psychological therapies, in particular cognitive behavioural therapy.

The authors conclude that poor sleep and insomnia are not always treated in accordance with current best practice. They say that although CBT is more effective for insomnia in the long term, medication is more commonly prescribed. They argue that people with chronic insomnia should be included in the Improving Access to Psychological Therapies (IAPT) programme, while most of those who sleep poorly would benefit from guided self-help methods based on CBT principles.

How can sleep quality be improved?

The report describes ways to improve one's sleep. This may involve making small adjustments to one's lifestyle, such as cutting down on caffeine and alcohol, taking physical exercise and having a regular bedtime. Those with more chronic problems may need medication (usually hypnotics), although these can have side effects and should be used with caution.

The authors say there is no set amount of sleep that is right for everyone, as optimum sleep periods can range between 5 and 11 hours. How much sleep is needed also tends to depend on age, with adolescents requiring more than adults and older people needing less.

The authors also point out that psychological approaches are recommended. In particular they recommend cognitive behavioural therapy (CBT), which they say is the most effective treatment for chronic insomnia, with research finding it associated with improvement in 70% of cases.

Conclusion

This report describes the nature of sleep and highlights its importance for physical and mental wellbeing, drawing on a number of different sources, both primary and secondary, and much of what it says in this area is uncontroversial. It also argues that greater emphasis should be placed on sleep problems by health policymakers.

However, as the authors note, the results of the survey it includes, which were widely reported, should be viewed with caution. The survey may not be completely representative of the UK population, since those who responded may be more likely to take an interest in their own sleep because they had problems sleeping. Furthermore, the survey has other limitations. It relies on people self-reporting their problems at one moment in time, on the internet, which could undermine the reliability of results. As such, the proportion of people in the survey who said they experienced insomnia and poor sleep cannot be applied to the UK population in general.

The report also cites several studies to support its statement that there is substantial evidence to show that that CBT is the most effective treatment for insomnia and is more effective than medication, in the long term. It is unclear what, if any, process was used to select this research.

What does this mean for me?

Most people suffer occasional sleep problems that clear up of their own accord. For anyone who is finding it difficult to go to sleep, or stay asleep, the current advice is to try taking simple behavioural steps such as always going to bed at the same time, adopting a relaxing routine to unwind, avoiding caffeine, alcohol and exercise late in the day and keeping bedroom temperatures comfortable. Those with a persistent problem should consult their GP. If you are concerned about taking medication, it may be worth asking about psychological therapies.